Article

Treatment options for massive rotator cuff tears.

Balgrist University Hospital, Zurich, Switzerland.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] (Impact Factor: 1.93). 03/2011; 20:S20-9. DOI: 10.1016/j.jse.2010.11.028
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    ABSTRACT: PURPOSE: The purpose of this study was to evaluate the results of arthroscopic cuff reconstruction, which is currently preferred in our service, and to compare functional outcome after arthroscopic cuff reconstruction comparing different types and sizes of rotator cuff tears. We switched completely from OPEN repair to the full-arthroscopic repair > ten years ago, and since then, we are developing a technique that can produce the best results. Therefore, we decided to verify results. METHODS: Seventy-two patients with rotator cuff tear underwent arthroscopic shoulder surgery. Single-row arthroscopic repair using double- loaded metal anchors and margin-convergence sutures with concomitant procedures were performed in all cases. All patients were assessed and classified before and after surgery using the Constant scoring system and the Oxford Shoulder Score. Tears were measured and classified as medium (1-3 cm), large(3-5 cm) and massive (>5 cm). RESULTS: The average age of participants was 59 ± 9 years (33-76). There were five medium, 43 large and 23 massive tears. The average functional Constant score at the last follow-up was 91.68 ± 10.62, and the Oxford score averaged 43.23 ± 5.84 without statistically significant differences (p > 0.05) among groups Best results were in the massive-tear group, with an overall Constant score of 98.60 ± 2.61 and an average Oxford score of 47.60 ± 0.55. Full recovery was obtained between six months and one year. We used our own modified rehabilitation protocol and found no postoperative stiffness in this series. CONCLUSIONS: Single-row arthroscopic rotator cuff repair using double-loaded metal anchors and margin- convergence sutures with concomitant procedures, when necessary, provides excellent results. Pain, range of motion, muscle strength and function were significantly improved after single-row repair among all morphological types of cuff lesions.
    International Orthopaedics 10/2014; 2(2):2. · 2.32 Impact Factor
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    ABSTRACT: Purpose: The objective of this study is to evaluate the functional outcome and identify prognosis of retear patients in patients aged 65 years or over undergoing surgical repair for a large to massive full-thickness rotator cuff tear. Materials and Methods: From 1995 September to 2010 March, 147 patients aged 65years or over (40 male, 107 female, with an average age of 69.6) undergoing surgical repair for large to massive full thickness rotator cuff tear (large 67 cases, massive 80 cases). For functional evaluation, preoperative and postoperative 1 year range of motion and muscle power checked. For subjective evaluation, American shoulder and elbow surgeons score and Constant score were checked. For anatomical evaluation, 87 patients were checked shoulder MRI at the time of the postoperative 1 year. Results: ASES score improved from to 50.4 to 88.9, Constant score improved from 47.1 to 75.2. Supraspinatus power improved from 51.1% to 80.8%, external rotator muscle power improved from 64.5% to 83.1%. Forward elevation improved from 117.4 degrees to 153 degrees, external rotation improved from 23.6 degrees to 41.8 degrees. Follow up MRI showed re-tear in 23%, all re-tear patients were from massive tear except one patient. All re-tear patients showed improved clinical outcomes, but supraspinatus and external rotator muscle power were not improved. Conclusions: Patients aged 65 years or over undergoing surgical repair for a large to massive full-thickness rotator cuff tear showed successful outcomes over 90 percent. Re-tear patients also showed successful clinical outcomes. In elderly patients with large to massive full thickness rotator cuff tear, aggressive surgical repair leads good clinical outcomes.
    The Journal of the Korean Shoulder and Elbow Society. 01/2012; 15(2).
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    ABSTRACT: Purpose Massive rotator cuff tears (MRCT) are usually chronic lesions that present associated degenerative changes of the myotendinous unit that have been implicated in limitations for surgical repair. In order to develop effective therapies, it is important to establish animal models that mimic the hallmarks of the injury itself. Therefore, in the present work, we aimed to (1) optimize a rodent animal model of MRCT that closely reproduces the fatty infiltration of the cuff muscles seen in humans and (2) describe the effects of unilateral or bilateral lesion in terms of histology and behaviour. Methods Massive tear was defined as two rotator cuff tendons—supraspinatus and infraspinatus—section. Twenty-one Wistar rats were randomly assigned to four groups: bilateral lesion (five animals), right-sided unilateral lesion (five animals), left-sided unilateral lesion (five animals) and control (six animals). Behaviour was analyzed with open field and staircase test, 16 weeks after lesion. After that, animals were killed, and the supraspinatus and infraspinatus muscles were processed. Results Histologic analysis revealed adipocytes, fatty infiltration and atrophy in the injured side with a greater consistency of these degenerative changes in the bilateral lesion group. Behaviour analysis revealed a significant functional impairment of the fine motor control of the forepaw analyzed in staircase test where the number of eaten pellets was significantly higher in sham animals (sham = 7 ± 5.0; left unilateral = 2.6 ± 3.0; right unilateral = 0 ± 0; and bilateral = 0 ± 0, p < 0.05). A trend to reach a lower level of steps, in more injured animals, was also observed (sham animals = 3 ± 1.6 > left unilateral = 2 ± 2.1 > right unilateral = 0.8 ± 1.3 > bilateral = 0.8 ± 1.1). Conclusions The present study has been able to establish an animal model that disclosed the hallmarks of MRCT. This can now be used as a valuable, cost-effective, pre-clinical instrument to assist in the development of advanced tissue engineered strategies. Moreover, this animal model overcomes some of the limitations of those that have been reported so far and thus represents a more reliable source for the assessment of future therapeutic strategies with potential clinical relevance.
    Knee Surgery Sports Traumatology Arthroscopy 11/2014; · 2.68 Impact Factor

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